Varicella-Zoster Virus Retinitis: Successful Evolution with a Combination of Antiviral Therapies

BACKGROUND: We present the description of a successful outcome in a case of varicella-zoster virus (VZV) acute retinal necrosis (ARN). HISTORY AND SIGNS: A healthy 40-year-old patient was admitted for a VZV retinitis. THERAPY AND OUTCOME: 10 days after the onset of intravenous (i. v.) acyclovir treatment, new small peripheral retinal necrotic lesions appeared in the right eye. A viral resistance was suspected and the acyclovir therapy was optimised with i. v. foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic or local complications were observed. CONCLUSIONS: VZV ARN is a severe infection with a poor prognosis. This case demonstrates that combination of antiviral therapies given intravenously (acyclovir + foscarnet) and in the vitreous (ganciclovir) may be safe and efficacious in the management of necrotising herpetic retinopathies affecting immunocompetent patients.